Angiographic evaluation and management of acute gastrointestinal hemorrhage

Figure 3 Angiographic diagnosis and transcatheter treatment of duodenal hemorrhage. A: Celiac digital subtraction angiography (DSA) arteriogram obtained in a patient with copious bleeding seen endoscopically in the duodenum shows focal contrast extravasation (black arrow) arising from the gastroduodenal artery (GDA); B: An image slightly later in the arterial phase of the DSA shows increasing extravasation (black arrow); C: The GDA was successfully coil embolized using microcoils (black arrowheads) through a microcatheter; D: An superior mesenteric artery DSA arteriogram was performed after the coil embolization in order to exclude any additional contribution to the duodenal hemorrhage from the pancreaticoduodenal arcade, as the duodenum has a rich collateral blood supply.